Provider Demographics
NPI:1871532358
Name:MAZZONE, JEANAE I (DO)
Entity type:Individual
Prefix:
First Name:JEANAE
Middle Name:I
Last Name:MAZZONE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:82 E. ALLENDALE ROAD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458
Mailing Address - Country:US
Mailing Address - Phone:201-236-8282
Mailing Address - Fax:201-236-0138
Practice Address - Street 1:51 ROUTE 23 SOUTH
Practice Address - Street 2:1ST FLOOR
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457
Practice Address - Country:US
Practice Address - Phone:973-831-4200
Practice Address - Fax:201-818-4888
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB06730700207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7635109Medicaid
NJ010976BHHMedicare ID - Type Unspecified
NJ7635109Medicaid